Standard and emerging CMR methods for mitral regurgitation quantification

Fidock, Benjamin; Archer, Gareth; Barker, Natasha; Elhawaz, Alaa; Al‐Mohammad, Abdallah; Rothman, Alexander; Hose, Rod; Hall, Ian; Grech, Ever; Briffa, Norman; Lewis, Nigel; Geest, Rob J. van der; Zhang, Junmei; Zhong, Liang; Swift, Andrew J.; Wild, Jim M.; Gárate, Estefania De; Bucciarelli-Ducci, Chiara; Bax, Jeroen J.; Plein, Sven; Myerson, Saul G.; Garg, Pankaj

doi:10.1016/j.ijcard.2021.01.066

Cited by 26 publications

(34 citation statements)

References 20 publications

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“…The present study data demonstrated that 4DF indirect is highly reproducible with higher concordance to standard CMR than 4DF direct . Recently, Fidock and colleagues [ 16 ] reported similar findings for primary MR. Nevertheless, they analyzed a small subgroup (n = 12), provided no direct comparison with TTE, and reported a rather low RVol (mean 28.6 ± 2.5 ml).…”

Section: Discussionmentioning

confidence: 57%

“…Recently 4D flow CMR was introduced and validated in vitro with phantom models [ 11 ], and first clinical experiences with healthy subjects and patients with MR demonstrated its feasibility. However, previous studies have been performed in functional MR [ 7 , 8 ], congenital heart disease [ 8 , 15 ], small study groups [ 10 , 16 ], or in rather mixed patient populations [ 9 , 11 , 12 , 16 ]. In the present study we investigated the clinical utility of 4D flow CMR in a homogeneous group of MVP patients.…”

Section: Discussionmentioning

confidence: 99%

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Quantification of regurgitation in mitral valve prolapse with four-dimensional flow cardiovascular magnetic resonance

Spampinato

Jahnke

Crelier

et al. 2021

Journal of Cardiovascular Magnetic Resonance

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Background Four-dimensional cardiovascular magnetic resonance (CMR) flow assessment (4D flow) allows to derive volumetric quantitative parameters in mitral regurgitation (MR) using retrospective valve tracking. However, prior studies have been conducted in functional MR or in patients with congenital heart disease, thus, data regarding the usefulness of 4D flow CMR in case of a valve pathology like mitral valve prolapse (MVP) are scarce. This study aimed to evaluate the clinical utility of cine-guided valve segmentation of 4D flow CMR in assessment of MR in MVP when compared to standardized routine CMR and transthoracic echocardiography (TTE). Methods Six healthy subjects and 54 patients (55 ± 16 years; 47 men) with MVP were studied. TTE severity grading used a multiparametric approach resulting in mild/mild-moderate (n = 12), moderate-severe (n = 12), and severe MR (n = 30). Regurgitant volume (RVol) and regurgitant fraction (RF) were also derived using standard volumetric CMR and 4D flow CMR datasets with direct measurement of regurgitant flow (4DFdirect) and indirect calculation using the formula: mitral valve forward flow - left ventricular outflow tract stroke volume (4DFindirect). Results There was moderate to strong correlation between methods (r = 0.59–0.84, p < 0.001), but TTE proximal isovelocity surface area (PISA) method showed higher RVol as compared with CMR techniques (PISA vs. CMR, mean difference of 15.8 ml [95% CI 9.9–21.6]; PISA vs. 4DFindirect, 17.2 ml [8.4–25.9]; PISA vs. 4DFdirect, 27.9 ml [19.1–36.8]; p < 0.001). Only indirect CMR methods (CMR vs. 4DFindirect) showed moderate to substantial agreement (Lin’s coefficient 0.92–0.97) without significant bias (mean bias 1.05 ± 26 ml [− 50 to 52], p = 0.757). Intra- and inter-observer reliability were good to excellent for all methods (ICC 0.87–0.99), but with numerically lower coefficient of variation for indirect CMR methods (2.5 to 12%). Conclusions In the assessment of patients with MR and MVP, cine-guided valve segmentation 4D flow CMR is feasible and comparable to standard CMR, but with lower RVol when TTE is used as reference. 4DFindirect quantification has higher intra- and inter-technique agreement than 4DFdirect quantification and might be used as an adjunctive technique for cross-checking MR quantification in MVP.

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Section: Discussionmentioning

confidence: 57%

Section: Discussionmentioning

confidence: 99%

Quantification of regurgitation in mitral valve prolapse with four-dimensional flow cardiovascular magnetic resonance

Spampinato

Jahnke

Crelier

et al. 2021

Journal of Cardiovascular Magnetic Resonance

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“…It allows the visualization of flow in multiple orientations to follow the spatial motion of the heart valves and the variable direction of the jets over time. The use of such a retrospective tracking method in a single volume acquisition covering the entire heart may enable direct MR jet volume quantification, overcoming certain limitations of 2D sequences ( 25 ). Recent reports have demonstrated its feasibility in mild to severe MR ( 26 ).…”

Section: Mitral Regurgitationmentioning

confidence: 99%

“…Recent reports have demonstrated its feasibility in mild to severe MR ( 26 ). However, its accuracy has usually been poor in comparison to 2D flow, especially in primary MR ( 25 ). This promising technique, which is constantly improving, is not yet commercially available for all scanners.…”

Section: Mitral Regurgitationmentioning

confidence: 99%

Role of Cardiovascular Magnetic Resonance in Native Valvular Regurgitation: A Comprehensive Review of Protocols, Grading of Severity, and Prediction of Valve Surgery

Vermès¹,

Iacuzio²,

Lévy³

et al. 2022

Front. Cardiovasc. Med.

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Valvular regurgitation is common in developed countries with an increasing prevalence due to the aging of the population and more accurate diagnostic imaging methods. Echocardiography is the gold standard method for the assessment of the severity of valvular heart regurgitation. Nonetheless, cardiovascular magnetic resonance (CMR) has emerged as an additional tool for assessing mainly the severity of aortic and mitral valve regurgitation in the setting of indeterminate findings by echocardiography. Moreover, CMR is a valuable imaging modality to assess ventricular volume and flow, which are useful in the calculation of regurgitant volume and regurgitant fraction of mitral valve regurgitation, aortic valve regurgitation, tricuspid valve regurgitation, and pulmonary valve regurgitation. Notwithstanding this, reference values and optimal thresholds to determine the severity and prognosis of valvular heart regurgitation have been studied lesser by CMR than by echocardiography. Hence, further larger studies are warranted to validate the potential prognostic relevance of the severity of valvular heart regurgitation determined by CMR. The present review describes, analyzes, and discusses the use of CMR to determine the severity of valvular heart regurgitation in clinical practice.

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“…Recently, four-dimensional (4D) flow CMR has emerged as an innovative imaging technique to quantitate MR based on a three-dimensional and time-resolved assessment of blood flow MR ( 102 ). Both in patients with primary MR and specifically in patients with MVP, quantification of mitral regurgitant volume has shown to be reproducible and feasible using 4D flow CMR ( 103 , 104 ). However, this technique requires additional acquisition and post-processing time and future studies are needed to evaluate a potential clinical outcome benefit over the indirect 2D CMR technique ( 102 ).…”

Section: Assessment Of Mitral Valve Prolapse Mitral Regurgitation Sev...mentioning

confidence: 99%

Left Ventricular Remodeling in Non-syndromic Mitral Valve Prolapse: Volume Overload or Concomitant Cardiomyopathy?

Pype

Bertrand

Paelinck

et al. 2022

Front. Cardiovasc. Med.

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Mitral valve prolapse (MVP) is a common valvular disorder that can be associated with mitral regurgitation (MR), heart failure, ventricular arrhythmias and sudden cardiac death. Given the prognostic impact of these conditions, it is important to evaluate not only mitral valve morphology and regurgitation, but also the presence of left ventricular (LV) function and remodeling. To date, several possible hypotheses have been proposed regarding the underlying mechanisms of LV remodeling in the context of non-syndromic MVP, but the exact pathophysiological explanation remains elusive. Overall, volume overload related to severe MR is considered the main cause of LV dilatation in MVP. However, significant LV remodeling has been observed in patients with MVP and no/mild MR, particularly in patients with bileaflet MVP or Barlow’s disease, generating several new hypotheses. Recently, the concept of “prolapse volume” was introduced, adding a significant volume load to the LV on top of the transvalvular MR volume. Another possible hypothesis is the existence of a concomitant cardiomyopathy, supported by the link between MVP and myocardial fibrosis. The origin of this cardiomyopathy could be either genetic, a second hit (e.g., on top of genetic predisposition) and/or frequent ventricular ectopic beats. This review provides an overview of the different mechanisms and remaining questions regarding LV remodeling in non-syndromic MVP. Since technical specifications of imaging modalities impact the evaluation of MR severity and LV remodeling, and therefore might influence clinical decision making in these patients, this review will also discuss assessment of MVP using different imaging modalities.

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Standard and emerging CMR methods for mitral regurgitation quantification

Cited by 26 publications

References 20 publications

Quantification of regurgitation in mitral valve prolapse with four-dimensional flow cardiovascular magnetic resonance

Quantification of regurgitation in mitral valve prolapse with four-dimensional flow cardiovascular magnetic resonance

Role of Cardiovascular Magnetic Resonance in Native Valvular Regurgitation: A Comprehensive Review of Protocols, Grading of Severity, and Prediction of Valve Surgery

Left Ventricular Remodeling in Non-syndromic Mitral Valve Prolapse: Volume Overload or Concomitant Cardiomyopathy?

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